Enhancing diagnostic accuracy of abnormal uterine bleeding classification by FIGO PALM–COEIN system and histopathological insight at a tertiary care center

Background

Abnormal uterine bleeding is one of the most common complaints amongst the non-pregnant females in the reproductive age group. To standardize terminology and abolish overlapping terms like menorrhagia, polymennorhoea, heavy menstrual bleeding the FIGO group introduced the PALM–COEIN system. The aim of the present study was to correlate the diagnostic accuracy of the clinical cause of abnormal uterine bleeding based on the PALM–COEIN system with the histopathological diagnosis of the resected surgical specimen.

Material and method

In this retrospective study, the medical records of patients with abnormal bleeding disorders over a one-year period were retrieved and classified according to the FIGO classification system; presence of structural abnormality (PALM) or its absence (COEIN group). This was correlated with histopathological diagnosis of the resected surgical specimen.

Result

384 abnormal uterine bleeding (AUB) patients were included in the study, 13 were myomectomy cases while rest underwent total abdominal hysterectomy. The predominant cause of AUB in the clinical PALM-COEIN classification was Leiomyoma (AUB-L 48.7 %) followed by the nonstructural causes of Ovulatory (AUB-O) and Endometrial (AUB-E) causes in 18 %. This was followed by Adenomyosis (AUB-A) in 16.9 %. The difference on the clinical and histopathological correlation was statistically significant (p = 0.03).

Conclusion

The histopathological examination plays a key role in the ultimate diagnosis, however classification of AUB based on the acronym PALM-COEIN provides a structured approach to identifying the underlying cause of AUB. The classification aids in standardizing the language used in AUB diagnosis. Its global application would help in better patient management.